Wound Healing Flashcards
What are the goals of wound healing
- minimize the spread of tissue damage
- control infection
- remove dead tissue
- regeneration of the injured tissue to its normal functioning state
Factors affecting wound healing
- oxygen
- moisture
- nutrition
- infection
Goals fo inflammation phase
- limit the extent of tissue damage
- limit the spread of infection
- remove necrotic tissue, debris, & pathogens
What does the wound look like during inflammation phase and its timing
- wound will look fresh, new, swollen, pink, & blood on the surface
-timing is from injury to 10 days
What happens during the inflammation phase
- coagulation & temporary decrease blood flow
- necrosis
- decrease spread of pathogens
- oxygen delivery
- set the stage & signal
What are the goals of proliferation and its timing
- rebuilding structure & framework of the wound
- timing is from day 3 to day 20
What happens during the proliferation phase
- new tissue from fibroblasts create collagen
- re-epithelialization &/or contraction
- angiogenesis
- granulation tissue
- epithelial cells creates type III collagen
- scar weak
Goals and timing of maturation/remodeling phase
-obtain complete wound healing & strength
- timing is from day 9 to 2 years
What happens during maturation/remodeling phase
- epithelial cells continue to form type 1 collagen
- granulation tissue is replaced by less vascular tissue
- scar formation
Describe primary intention
- surgical closure of wound
- stages of healing pass through on a similar scale
Define dehiscence
- primary closure re-opens
Describe secondary intention
- wound heals on its own
- tissue migrates, pulls to close, no new tissue formed
- disfiguring scars & impaired function
Describe tertiary intention
- delayed primary intention
- healing begins with secondary then closed by primary
- delay generally due to presence of infection
Role of oxygen in wound healing
- O2 is delivered to the wound through the blood
- O2 supports collagen deposition, angiogenesis, & granulation
- decreased O2 increases likelihood of infection
What can limit perfusion
- edema
- necrosis
- vasoconstriction
What can improve perfusion
- warmth
- avoiding smoking
- hydration
- controlling pain & anxiety
Role of moisture in wound healing
- most important external factor
- autolytic debridement
- clean moist wound bed is the best environment for wound healing
Vital nutrients in wound healing
- protein for amino acids
- iron, vitamin B12, & folic acid
- vitamin C & zinc
- vitamin A
- arginine
Clinical signs of abnormal inflammation phase
- drainage
change in color/odor - lingering swelling
- eschar/necrosis
- peri wound maceration
- chronic inflammation
- tunneling
- undermining
- infection
Clinical signs of abnormal proliferation phase
- lack of keratinocyte migration
- epithelial cells unable to migrate
- granulation is absent, pale, or delayed
- tissue breakdown
- tunneling, eschar, peri wound maceration
- continued inflammatory signs
Clinical signs of abnormal maturation/remodeling phase
- break down with minimal trauma
- hypertrophic scar
- keloid scar
Signs of infection
- change in drainage
- swelling
- peri wound
- quality of granulation tissue
- no changes in size
- fever, nausea, fatigue
Effects of infection
- insufficient cellular activity
- decreased oxygen
- increased cell necrosis
- decline of body systems
Intrinsic factors of abnormal wound healing
- hypoxemia
- aging
- underlying disease
What happens to the skin with aging
- decreased elasticity
- collagen
- mast cell production
- vascularity
- pain receptors
- fat & rate pegs
Extrinsic factors of abnormal wound healing
- effects of radiation or chemotherapy
- incontinence
- medications
- smoking
- recreational drugs
- dehydration & malnutrition
- stress
Iatrogenic factors of abnormal wound healing
- poor wound management & dressing changes
- cytotoxic topical agents
- lack of moisture
- cross contamination
- lack of sterile or clean technique
- lack of standard precautions
- injuries & pressure
Complications related to abnormal wound healing
- impairments in body functions & structures
- restrictions in activity & participation
- assisted living or homeware services
- decreased quality of life
- depression
- infection
- loss of limb
- death
